Immortality Medicine

One in five heavy smokers over age 40 have findings of COPD, but only one-third have been previously diagnosed with the common lung disease.

10% of people worldwide over the age of 40 are affected by COPD.

Researchers screened 1,003 people aged 40 and over who were current or former heavy smokers. Heavy smoking was defined as a smoking history of 20 pack-years or more.

The results showed that 20.7% of the people screened met the criteria for a diagnosis of COPD but only 32.7% had previously been diagnosed with the disease or were aware of their COPD diagnosis.

Kylie Minogue on cancer – Friday Night with Jonathan Ross – BBC One.

Only 27% of men who used Propecia (finasteride) said it was “very” effective. Finasteride is a 5-alpha reductase inhibitor used to treat prostate enlargement symptoms and baldness. Finasteride has 2 trade names: Propecia for baldness and Proscar for BPH.

Over-the-counter minoxidil (Rogaine) is applied directly to the scalp and is the only hair regrowth drug approved for use by women. Just 4% of respondents said it was very effective, with 43% of users saying it was not effective at all.

Only 2% of men surveyed underwent hair transplants; but of these, 49% were either very or completely satisfied with the results of their surgery, the poll shows.

Science 2.0 will come: More publishing but less (legitimate) publishers? http://bit.ly/dmx37u and http://bit.ly/bJyxkw

You can find this information on PubMed but this is a nice summary from UpToDate (only brief highlights are posted below, check the source link for full text):

Sexually transmitted infections

25% of urban adolescent females (14-17 years of age) were diagnosed with a sexually transmitted infection (STI) within one year of first intercourse.

Attention deficit hyperactivity disorder (ADHD)

ECG screening should not be required before initiating stimulant therapy for patients with ADHD.

Autism prevalence

The prevalence of autism spectrum disorders (ASD) among eight-year-old children in the United States increased from 1 in 150 children in 2000 to 2002 to approximately 1 in 111 in 2006. No clear reason for increase has been found.

The choking game

5.7% of eighth-graders had participated in the self-strangulation activity known as “the choking game”. Recognize signs of these activities: bruising or red marks on the neck; wearing high-necked shirts, even in warm weather; bloodshot eyes or pinpoint bruising around the eyes; petechiae on the face, especially the eyelids or conjunctiva.

HPV vaccine

The US Food and Drug Administration (FDA) approved the use of quadrivalent human papillomavirus vaccine in males aged 9 through 26 years to reduce their likelihood of acquiring genital warts.

13-valent PCV

The FDA approved a 13-valentpneumococcal conjugate vaccine (PCV13). PCV13 adds serotypes 1, 3, 5, 6A, 7F, and 19A to those contained in the PCV7, the 7-valent vaccine (4, 6B, 9V, 14, 18C, 19F, and 23F). The six additional serotypes accounted for 63% of invasive pneumococcal disease among children younger than five years of age.

References:
What’s new in pediatrics. UpToDate.

Direct link here.

23andMe is a personal genomics company based in Mountain View, California that is analyzes saliva samples for genetic information (the average cost for the service is decreasing and is currently $399-$499).

The company name is a play on the 23 pairs of chromosomes that carry every individual’s DNA. 23andMe was co-founded by Anne Wojcicki, wife of Google co-founder Sergey Brin.

Fasting glucose is the standard measure used to diagnose diabetes in the United States. Recently, glycated hemoglobin was also recommended for this purpose.

The glycated hemoglobin value at baseline was associated with newly diagnosed diabetes and cardiovascular outcomes.

For glycated hemoglobin, values of less than 5.0%, 5.0-5.5%, 5.5-6.0%, 6.0-6.5%, and 6.5% or greater, the hazard ratios for diagnosed diabetes were 0.52, 1.00, 1.86, 4.48, and 16.47, respectively.

For coronary heart disease, the hazard ratios were 0.96, 1.00, 1.23, 1.78, and 1.95, respectively. The hazard ratios for stroke were similar.

In contrast, glycated hemoglobin and death from any cause were found to have a J-shaped association curve.

The association between the fasting glucose levels and the risk of cardiovascular disease or death from any cause was not significant.

In this community-based population of nondiabetic adults, glycated hemoglobin was associated with a risk of diabetes and more strongly associated with risks of cardiovascular disease and death from any cause as compared with fasting glucose. These data add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes.

References:

Researchers found that people working in a dimly lit room were more likely to cheat about their own performance on a task in order to earn more money than people working in a well-lit room.

Darkness may create a sense of illusory anonymity that disinhibits self-interested and unethical behaviors. It appears to induce a false sense of concealment, leading people to feel that their identities are hidden.

References:
Dim Lighting and Sunglasses Encourage Unethical Behavior in Study. WebMD.
Image source: Ray Ban Original Wayfarer, Wikipedia, Creative Commons Attribution-Share Alike 3.0 Unported license.

Comments from Twitter and Facebook:

@scanman: RT @DrVes: when working in a dimly lit room http://goo.gl/fb/erLEf

@doctorwhitecoat: Clubbing/bars? RT @DrVes People behaved more selfishly/dishonestly when in a dimly lit room or when wearin sunglasses http://goo.gl/fb/erLEf

For hundreds of years people have practiced the Chinese martial art of Tai Chi for its many health benefits. Researchers who study Tai Chi say it can help reduce blood pressure, decrease anxiety, improve flexibility and much more. For these reasons, some doctors at Mayo Clinic have embraced Tai Chi and are teaching it to their patients.

From Wachter’s World:

“In 1984, one resident even wrote a letter to the New England Journal of Medicine called “Ripping and Filing Journal Articles,” taking the Journal to task for its habit of beginning an article on the back of the last page of the previous one (which meant the page needed to be photocopied if you wanted to tear both articles out of your personal copy of the journal). Fair point, but talk about a resident who needed to get a life.

Today, as in so many other parts of our lives, the computer, with its magical access to the universe of on-line resources, has democratized the learning of clinical medicine. At UCSF, by the time morning rolls around, the students and interns have often already read the on-line UpToDate synopsis of the topic at hand, and may be as capable of teaching the resident (or attending) about it as visa versa.”

Driving while talking on a cell phone is extremely hazardous for most people.

Only a tiny fraction of “supertaskers” can do both simultaneously without ill effect – 2.5% of people studied could successfully drive and use a cell phone at the same time.

It took most people 20% longer to hit the brakes and increased following distances 30%, meaning they failed to keep pace in the simulator with virtual traffic. Also, their memory performance dropped 11% and their ability to do the math fell 3%.

Video: Stop texting while driving (http://bit.ly/S6osm). Terrifying. All drivers should watch this. Warning: This video may not be suitable for minors.

References:
97.5% Can’t Drive Safely Using Cell Phones. WebMD.
Video: Stop texting while driving. Terrifying. All drivers should watch this.
Texting while driving increases crash risk 23 times

A study included M.R.I.’s of the hips of 21 professional hockey players and 21 college players. They showed abnormalities in 70 percent of the athletes, even though these hockey players had no pain or only minimal discomfort that did not affect their playing. More than half had labral tears, rips in the cartilage that stabilizes the hip.

“M.R.I.’s are so sensitive,” Dr. Musahl said. “They frequently show little tears or fraying everywhere. And it is very, very common to have a small labral tear in your hip — it doesn’t mean you have to have the particular symptoms.”

References:
Personal Best – Sports Injuries – Go to a Doctor or Tough It Out? NYTimes.com.

Mayo Clinic emphasizes living donor kidney transplants as the best option for patients. Martin Mai, M.D., nephrologist at Mayo Clinic offers information about living donation, statistics, including the fact that living donor kidneys last longer. Half of living donor kidneys transplanted today will still be functioning 25 years from now, whereas half of cadaveric kidneys will fail in the first 10 years.

Candy and Ellen’s Story.

The rapid expansion of the Internet has increased the ease with which the public can obtain medical information. Most research on the utility of the Internet for health purposes has evaluated the quality of the information or examined its impact on clinical populations. Little is known about the consequences of its use by the general population.

Health-related Internet use was associated with small but reliable increases in depression (i.e., increasing use of the Internet for health purposes from 3 to 5 days per week to once a day was associated with 0.11 standard deviations more symptoms of depression, P = 0.002).

Using the Internet for health purposes was associated with increased depression. The increase may be due to increased rumination, unnecessary alarm, or over-attention to health problems.

In contrast, using the Internet to communicate with friends and family was associated with declines in depression.

References:

Occasional heavy drinking was defined as having 5 or more standard drinks in a day at least 12 times per year. “Regular” heavy drinkers – those who averaged at least 5 drinks per day, were excluded from the analysis.

In general, moderate drinking – a drink or two per day – is considered a potentially heart-healthy habit. A number of studies have found that moderate drinkers have lower risks of heart disease than teetotalers do.

Research suggests that alcohol can increase “good” HDL cholesterol, has anti-inflammatory effects in the blood vessels and may make the blood less prone to clotting.

On the other hand, regular heavy drinking may increase blood pressure, promote blood clotting and contribute to development of arrhythmias.

References:
Occasional binges may undo alcohol’s heart benefits. Reuters, 2010.

From TIME:

Another blast from Europe’s medieval medical past are medicinal leeches. Similar to bloodletting, leeches were utilized to draw out the “bad blood” that medieval physicians believed caused many of their patients’ ailments.

Top 10 Bloodsuckers: Leech.AnimalPlanetTV.

Not what it seems: Desert Island (click to enlarge the image). The obvious is sometimes hidden – this often applies to clinical evaluation of patients and research.

References:
http://xkcd.com/731

Ruben Mesa, M.D., describes his experience using YouTube videos to provide in-depth information about blood cancers.

For patients with dementia, the following characteristics are useful for identifying
patients at increased risk for unsafe driving:

- Clinical Dementia Rating scale (Level A)
- caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)
- history of crashes or traffic citations (Level C)
- reduced driving mileage or self-reported situational avoidance (Level C)
- Mini-Mental State Examination scores of 24 or less (Level C)
- aggressive or impulsive personality characteristics (Level C)

Evaluation of driving risk in dementia (click to enlarge the image).

The following characteristics are not useful for identifying patients at increased risk for unsafe driving:

Walgreens Wound Closure Adhesive Strips: adhesive strips used to secure, close and support small cuts and wounds.

Video: Awake Endotracheal Intubation for “Fun and Knowledge” by an anesthesiologist from the Massachusetts General Hospital (MGH). Not sure about the “fun” part…

References:
Awake Endotracheal Intubation for Fun and Knowledge. Medgadget, 2010.

Takotsubo cardiomyopathy (also called stress induced cardiomyopathy, apical ballooning, or broken heart syndrome) was first described in Japan 20 years ago. It is typically precipitated by acute emotional stress, hence the names “stress cardiomyopathy” or “broken-heart syndrome.”

Takotsubo cardiomyopathy is characterised by acute, reversible left ventricular dysfunction in a distribution,which does not correlate with the coronary artery blood supply. The left ventricular dysfunction occurs without obstructive coronary artery disease (CAD) and usually resolves spontaneously over a period of weeks.

The characteristic appearances on contrast angiography include:

Reduced saturated fat (SFA) consumption is recommended to decrease coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.

The overall pooled risk reduction was 19% (RR = 0.81), corresponding to 10% reduced CHD risk (RR = 0.90) for each 5% energy of increased PUFA.

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

Initiating metformin soon after diabetes diagnosis and while A1C is low might preserve ?-cell function, prolong the effectiveness of metformin, reduce lifetime glycemic burden, and prevent diabetes complications.

These findings support the current treatment algorithm for hyperglycemia management that recommends metformin initiation when diabetes is first diagnosed.

Video: How the Body Works – The Pancreas.

References:

Homozygous familial hypercholesterolaemia is a rare genetic disorder in which both LDL-receptor alleles are defective, resulting in very high concentrations of LDL cholesterol in plasma and premature coronary artery disease. This study investigated the use of an antisense inhibitor of apolipoprotein B synthesis, mipomersen, to lower LDL cholesterol.

Patients aged 12 years and older who were already receiving the maximum tolerated dose of a lipid-lowering drug, were randomly assigned to mipomersen 200 mg subcutaneously every week or placebo for 26 weeks.

34 patients were assigned to mipomersen and 17 to placebo. Mean concentrations of LDL cholesterol at baseline were 11·4 mmol/L in the mipomersen group and 10·4 mmol/L in the placebo group. The mean percentage change in LDL cholesterol concentration was significantly greater with mipomersen (?24·7%) than with placebo (?3·3%).

The most common adverse events were injection-site reactions in 76% of patients in mipomersen group vs 24% in placebo group. 12% of patients in the mipomersen group had increases in alanine aminotransferase of three times or more the upper limit of normal.

Inhibition of apolipoprotein B synthesis by mipomersen represents a novel, effective therapy to reduce LDL cholesterol concentrations in patients with homozygous familial hypercholesterolaemia who are already receiving lipid-lowering drugs, including high-dose statins.

References:
Mipomersen, an apolipoprotein B synthesis inhibitor, for lowering of LDL cholesterol concentrations in patients with homozygous familial hypercholesterolaemia: a randomised, double-blind, placebo-controlled trial. The Lancet, Volume 375, Issue 9719, Pages 998 – 1006, 20 March 2010.